POTUS

When I was in 8th grade, it was the year of the Bush-Gore election.  My 8th grade history teacher had each of us watch the 3 debates and create a list of what was each president-elect's stance on various "big ticket" items.  At that time, debates were civil, and each candidate spoke of their beliefs (or at least what they thought their respective parties wanted to hear).  There was very little lambasting of each other's character or moral ground.  I felt like having true debates led to more discussions of why one person thinks one way and another person thinks another way.  People did not lose friends over this sharing of beliefs.

Seemingly, those days are gone.  This year's debates were not debates.  They were several hours of two people shouting loud enough to try to drown out the other person.  They were random accusations, "he said-she saids", and disrespectful comments and slurs abounded.  It was like watching two toddlers kick sand in each others faces and then argue over who started it.  It was demeaning, unsettling, and frankly, neither candidate had an opportunity to discuss their stance on why they would be best at running our country because neither was quiet long enough to hear what the other was saying.

My greatest fear is having a POTUS who cares more about what he or she has to say than what the people in their cabinet, in congress, and the general population have to say.  I was told by one of my mentors that the most important thing you can do when entering a new position is to remain silent for the first 6 months of meetings and gatherings in order to get the lay of the land and what each of the other members has to offer.  I wish I could say that both candidates for presidency were able to do this.  However, one has been in government so long that she has already taken her time of silence and potentially would have forgotten she's in a new position.  The other has been the president of his own company, and demands others listen to him and do what he says.  That is all well and good when you are president of a company, but the ramifications of speaking without thinking as POTUS are far greater when we're talking about maintaining domestic peace and continuing partnerships with foreign delegates.

I want to say that in this time of continued divisiveness, of unrest, we have a leader who will be able to unite all.  My concern is that he has fed into the hate that leads to the harsh words we use against each other.  It is not unlike Star Wars, and as Yoda once said, "Fear is the path to the Dark Side.  Fear leads to anger.  Anger to hate.  Hate leads to suffering".  We all suffer even when the hate isn't necessarily directed at us.

We, as a nation, are fortunate to have the freedoms to express ourselves however we choose.  We are not constrained to certain belief patterns set before us.  We are not supposed to be afraid to state our minds, follow our chosen religion, read whatever catches our fancy, or choose who we marry or spend our time with.  We can learn from each other through exploration of others cultural backgrounds, belief systems, or differences of opinions.  We grow through learning about others.  Disagreeing on a topic of conversation is not a complete attack on that entire person, it's simply a place where two people can begin to dissect why they approach the same idea from different angles.

I do not consider myself a great debater.  I have never been good at voicing my opinions, especially when someone puts me on the spot.  I do not think well on my feet, and generally cannot come up with an eloquent response when confronted.  Several days later, I might have a response, but not in the moment.  However, I do stand by the fact that no one should be attacked for who they are as a person.  We do not have the right to decide that because we think one group is different, they must be ostracized.  This is how Hitler used his power in Nazi Germany.  He terrorized the people and tortured them for not carrying out his demands to purge the nation of those he considered "unclean" and "unfit".  The fear was so overpowering, no one dared stand up and say, "but you like look those that you are asking us to kill".  Some recent statements have come eerily close to the idea that we will be great if we are all the same.  I beg to differ and think that it is because of our differences and our ability to still work together despite our differences that makes us great.

As Tom Robbins said, "Our similarities bring us to common ground; our differences allow us to be fascinated by each other".  We are great at pointing out all of our differences, but now, more than ever, we need to rediscover our similarities.  We are all capable of loving and learning from each other; let's not allow ignorance, fear, and bigotry define our nation.  We cannot follow the path seen in the movie "Idiocracy".  We, as a nation, are a world leader, and we need to start acting like adults again.  We can show what a role model looks like, but we first have to start showing the characteristics we value in order to force our leaders to step up and act the role of model citizen.

If someone needs a reminder, starting with the Golden Rule of doing unto others as you would have them do unto you is a start.  This goes for everyone; we have all purposefully said mean and hateful things out of our own pain, but there is no benefit in dragging others down with you.  We will all only end up at the bottom of a dark pit without a way out.  If we are able to take a step back from our pain and instead reach out to help and support others, it diminishes the sadness and fear.  If you empower those around you, they in turn, can empower those around them.  While wildly idealistic, we stand to benefit more from supporting and caring for our fellow man than trying to tear them down piece by piece.  We are only as strong as our weakest members, so if we strengthen and build them up, it benefits our entire society.  Care for each other, we are all we have left.

Choice

We all have decisions to make.  They are neither good nor bad, right or wrong.  They are merely the choice we choose to follow.

Sometimes we choose indecisiveness.  We worry incessantly about how our decisions will be viewed, so we opt to not make any choice.  We assume that the passivity will make the choice disappear, fade away, no longer be our problem.  The reality is that indecisiveness leads to a longer path that only ends at the same decision.  Sometimes, that's what is needed.  We need more time to face the music, and realize that the extra maturity makes the choice more clear in our minds.  The act of rolling the stone around for a while smooths the edges, making what was once painful, less so.  We are initially indecisive out of fear of the fallout, yet with the tincture of time, the monster of our thoughts gives way to the minuteness of actuality.

Sometimes we choose the bold, brash choice.  We shout our feelings and beliefs into the wind, caring little about how others will view us.  We are emboldened by our quick judgement, our lack of duress.  We lay our line in the sand and dare others to cross us.  We know that there is no other choice in the current decision.  It is freeing to not have to wait to come to the conclusion.  We are here.  We have made it!  The stage is set, and curtain is closed.

Sometimes we let others choose for us.  We create lists of pros and cons, spreadsheets, analyses that at once illuminate and darken the decision.  We involve friends and family.  We become paralyzed by the overwhelming possibility that no matter what we do, we can't make everyone happy at the same time.  So instead of us being the bad guys in the story, we pass the decision to someone else, and then take the credit for the choice that was made.

I think the events of the last several months have illuminated the paths our choices can take us on.  We are also left wondering if things would be different under other circumstances.  We will never know the outcome of how things could have been, but a choice has been made, a leader set.  We are all under the path for the next four years that was set by the choices of the majority, but not all.  We are in this together, and together must support and love those around us.

Physician Suicide

The last 24-hours has been rife with reflection.  I learned recently of the suicide of one of my friends from medical school as she was completing her residency and preparing for her board examination.  Guilt fills me thinking that I was less than two hours away, and lost track once residency started.  Could I have changed the outcome if I had been there for her?  Would it have even made a difference?  How many other people are feeling lost, hopeless, and helpless to change their situation?  Is there something we can do as a medical community to care for each other the way we care for our patients each day?  The facts,  at present, are staggering (from the American Foundation for Suicide Prevention):

• Each year in the U.S., roughly 300–400 physicians die by suicide, and this is an underestimate.
• In the U.S., suicide deaths are 250–400 percent higher among female physicians when compared to females in other profession.
• In the general population, males complete suicide four times more often than females. However, female physicians have a rate equal to male physicians.
• Medical students have rates of depression 15 to 30 percent higher than the general population. Depression is a major risk factor in physician suicide. Other factors include bipolar disorder and alcohol and substance abuse.
• Women physicians have a higher rate of major depression than age-matched women with doctorate degrees.
• Contributing to the higher suicide rate among physicians is their higher completion to attempt ratio, which may result from greater knowledge of lethality of drugs and easy access to means.

How did we get to this point?  Fear of ridicule for appearing weak, jeopardizing patient trust, and lack of understanding from hospital administration seems to rank among the top reasons why doctors let their pain fester inside until the only salvation seems to be death.

I had a terrible start to intern year of residency.  Hours were long,  the number of notes I had to complete was seemingly insurmountable, I lost sight of the beauty in caring for other people and became a cog in the never-ending machine of a hospital.  I was abused and belittled by consultants and transferring physicians alike, left to feel like I was causing more trouble by being there.  After a particularly difficult week of nights (my second week as an intern), I came home to sit on my living room floor and sob.  As sad as it may sound to some, if it had not been for my two cats, I probably would have given up on a career that I now love so dearly.  Their unconditional love in that moment steeled me from putting on paper the letter of resignation I had been planning in my head the entire night I was awake.  While not a suicide note, it would have been the end of who I had become up to that point, and I would never have had the opportunity to be the person I am today.

The following week, I had my first day of clinic with my preceptor.  He was incredibly caring toward the residents he worked with and his patients.  Unfortunately,  he is now no longer practicing as a clinical physician due to his own burnout in the medical field.  However,  on that day, he took the time to ask how I was doing.  I told him about the events of the week before, and the resignation letter I had almost written.  He told me a story of how one of my favorite residents from the class above me, my preceptor himself, and several of the other physicians I viewed as role models had all been in the same place I was the week prior.  They had all penned letters of resignation, and then for one reason or another, never submitted them.  Some had preceptors,  like mine,  who made them feel heard; others had interventions from chief residents.  Regardless,  though,  he said that all residents have that moment of complete hopelessness.  At the time, this solidarity in misery was a relief.

Now, in looking back, I realize that despite our better attempts, we are all feeding into a system that fosters toxicity.  Why should I feel relieved to know that others have suffered the way I have?  Why do I still tell other residents the story above to show them even the most "nauseatingly positive" resident has had moments of self-loathing?  Is this part of the reason we have the highest rate of suicide?  Is it because even those of us who make it through wear our darkest moments like purple hearts?  We prove ourselves by pulling out stories of self deprecation, burnout, hopelessness, and loss of faith in our abilities.  We are not improving the broken system by sharing these stories like they are a right of passage.  Instead, we should share these stories as an opening to accepting the vulnerabilities of our fellow physicians.  We can only heal our system by first working together to heal ourselves.  This culture of destruction will get us nowhere.

Strength comes in opening up, allowing ourselves to be vulnerable such that other physicians feel they can also come forward and speak the unspoken.  What would happen if, as a fellow physician, I was present for one of my own who was in need?  What if I took the time to hear the pain one of my colleagues is currently going through?  Would it make a difference?  Even if I don't have the expertise to do more than hear them and sit with them in that pain, would that be enough?  Could I open the door to obtaining necessary mental health care that would be able to provide that person the support they need to continue in a career they were so excited to become part of in medical school?

Is there more we can do at the medical school level to provide students with the tools they need to speak up when they are hurting?  Can we be present for them to share their darkest thoughts and feelings?  Would other female physicians-in-training benefit from knowing that imposter syndrome is real and likely a huge driver for female physician suicide?  What can we do to improve their self esteem, to let them know that while the feeling of being an imposter never fully goes away, it can be dampened so we can continue to be huge advocates in the field of medicine and for our patients?  How can we create an interdisciplinary team for ourselves like we do for our patients?

Medicine as a career is isolating in and of itself, but we become even more isolated by turning our backs on each other.  In general, the only other people who can fully understand the suffering and pain medical professionals see and care for are other medical professionals.  If we ridicule each other for succumbing to the normal physical and emotional reactions to repeated trauma, then we only do a disservice to our community.  When our comrades have no one to turn to, drowning and numbing the pain because the first alternative.  When that is no longer enough, then death can become the most appealing outlet for the deluge we cannot hold back on our own.  Our hope is always that someone will first hear our cries for help, and grab hold until the storm passes, the current slows, and we are able to pull ourselves out of the mire and to the safety of shore.  When this all too often doesn't happen, the easiest course is to give in to the pull of darkness, and quit fighting.  Let's start building rafts and lifeboats for each other instead of reacting only to the shock of watching another physician's lifeless body go over the waterfall and disappear from sight.